腎細胞癌以腹壁轉移為表現之罕見病例

康庭碩、黃勝賢

彰化基督教醫院 外科部 泌尿科

Unusual Presentation of Renal Cell Carcinoma with Abdominal Wall Metastasis

Ting-Shuo Kang, Sheng-Hsien Huang

Divisions of Urology, Department of Surgery, Changhua Christian Hospital

Introduction:

Renal cell carcinoma (RCC) has a well-known tendency to metastasize to unusual locations, though isolated abdominal wall involvement is exceedingly rare, occurring in less than 3–6% of cases. Such metastases may appear as the first sign of disease or arise years after nephrectomy, posing diagnostic and therapeutic challenges. We report a case of chromophobe RCC with sarcomatoid differentiation that developed aggressive abdominal wall metastases despite multimodal systemic therapy.

Case presentation:

A 63-year-old man was incidentally found to have a 4 cm right renal mass in July 2023. Biopsy and subsequent partial nephrectomy confirmed chromophobe renal cell carcinoma (RCC) with sarcomatoid differentiation (pT1b, grade 4) and lymphovascular invasion. Nine months later, he developed a right abdominal wall mass, which pathology confirmed as metastatic sarcomatoid RCC. Sequential systemic therapies—including sunitinib, cabozantinib, nivolumab, everolimus, and pembrolizumab—were administered with temporary responses. Despite multimodal treatment and repeated surgical resections, he experienced recurrent abdominal wall metastases, local renal recurrence, and distant spread to the pleura and bone, reflecting aggressive disease progression.